1114264934 NPI number — ALLIANCE DENTAL SPECIALTIES OF EAST BRUNSWICK

Table of content: (NPI 1114264934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114264934 NPI number — ALLIANCE DENTAL SPECIALTIES OF EAST BRUNSWICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE DENTAL SPECIALTIES OF EAST BRUNSWICK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLIANCE DENTAL SPECIALTIES OF PARSIPPANY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114264934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 NEWMAN SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCROFT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07738-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-842-5915
Provider Business Mailing Address Fax Number:
732-842-5910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 US HIGHWAY 46
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
PARSIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07054-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-334-2255
Provider Business Practice Location Address Fax Number:
732-842-5910
Provider Enumeration Date:
01/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FRATTELLONE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-842-5915

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  22DI00905200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X , with the licence number: 22DI02512700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 22DI00905200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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